Advertisement

An anatomic risk model to screen post endovascular aneurysm repair patients for aneurysm sac enlargement

Published:December 27, 2016DOI:https://doi.org/10.1016/j.jss.2016.12.024

      Abstract

      Background

      Follow-up computed tomography angiography (CTA) scans add considerable postimplantation costs to endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs). By building a risk model, we hope to identify patients at low risk for aneurysm sac enlargement to minimize unnecessary CTAs.

      Methods

      895 consecutive patients who underwent EVAR for AAA were reviewed, of which 556 met inclusion criteria. A Probit model was created for aneurysm sac enlargement, with preoperative aneurysm morphology, patient demographics, and operative details as variables.

      Results

      Our final model included 287 patients and had a sensitivity of 100%, a specificity of 68.9%, and an accuracy of 70.4%. Ninety-nine (35%) of patients were assigned to the high-risk group, whereas 188 (65%) of patients were assigned to the low-risk group. Notably, regarding anatomic variables, our model reported that age, pulmonary comorbidities, aortic neck diameter, iliac artery length, and aneurysms were independent predictors of post-EVAR sac enlargement. With the exception of age, all statistically significant variables were qualitatively supported by prior literature. With regards to secondary outcomes, the high-risk group had significantly higher proportions of AAA-related deaths (5.1% versus 1.1%, P = 0.037) and Type 1 endoleaks (9.1% versus 3.2%, P = 0.033).

      Conclusions

      Our model is a decent predictor of patients at low risk for post AAA EVAR aneurysm sac enlargement and associated complications. With additional validation and refinement, it could be applied to practices to cut down on the overall need for postimplantation CTA.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Veith F.J.
        • Marin M.L.
        • Cynamon J.
        • Schonholz C.
        • Parodi J.
        1992: Parodi, Montefiore, and the first abdominal aortic aneurysm stent graft in the United States.
        Ann Vasc Surg. 2005; 19: 749-751
        • Propper B.W.
        • Abularrage C.J.
        Long-term safety and efficacy of endovascular abdominal aortic aneurysm repair.
        Vasc Health Risk Manag. 2013; 9: 135-141
        • Dangas G.
        • O'Connor D.
        • Firwana B.
        • et al.
        Open versus endovascular stent graft repair of abdominal aortic aneurysms: a meta-analysis of randomized trials.
        JACC Cardiovasc Interv. 2012; 5: 1071-1080
        • Eskandari M.K.
        • Yao J.S.
        • Pearce W.H.
        • et al.
        Surveillance after endoluminal repair of abdominal aortic aneurysms.
        Cardiovasc Surg. 2001; 9: 469-471
        • Chaikof E.L.
        • Brewster D.C.
        • Dalman R.L.
        • et al.
        SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary.
        J Vasc Surg. 2009; 50: 880-896
        • Shah A.
        • Stavropoulos S.W.
        Imaging surveillance following endovascular aneurysm repair.
        Semin Interv Radiol. 2009; 26: 10-16
        • Manning B.J.
        • O'Neill S.M.
        • Haider S.N.
        • Colgan M.P.
        • Madhavan P.
        • Moore D.J.
        Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography.
        J Vasc Surg. 2009; 49: 60-65
        • Schanzer A.
        • Greenberg R.K.
        • Hevelone N.
        • et al.
        Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair.
        Circulation. 2011; 123: 2848-2855
        • Abedi N.N.
        • Davenport D.L.
        • Xenos E.
        • Sorial E.
        • Minion D.J.
        • Endean E.D.
        Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): an analysis using the ACS NSQIP dataset.
        J Vasc Surg. 2009; 50 (491.e1-4): 486-491
        • Lim S.
        • Halandras P.M.
        • Park T.
        • et al.
        Outcomes of endovascular abdominal aortic aneurysm repair in high-risk patients.
        J Vasc Surg. 2015; 61: 862-868
        • Nakai M.
        • Ikoma A.
        • Sato H.
        • Sato M.
        • Nishimura Y.
        • Okamura Y.
        Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair.
        Diagn Interv Radiol. 2015; 21: 195-201
        • Boult M.
        • Maddern G.
        • Barnes M.
        • Fitridge R.
        Factors affecting survival after endovascular aneurysm repair: results from a population based audit.
        Eur J Vasc Endovasc Surg. 2007; 34: 156-162
        • Barnes M.
        • Boult M.
        • Maddern G.
        • Fitridge R.
        A model to predict outcomes for endovascular aneurysm repair using preoperative variables.
        Eur J Vasc Endovasc Surg. 2008; 35: 571-579
        • Barnes M.
        • Boult M.
        • Thompson M.M.
        • Holt P.J.
        • Fitridge R.A.
        Personalised predictions of endovascular aneurysm repair success rates: validating the ERA model with UK Vascular Institute data.
        Eur J Vasc Endovasc Surg. 2010; 40: 436-441
        • Wisniowski B.
        • Barnes M.
        • Jenkins J.
        • Boyne N.
        • Kruger A.
        • Walker P.J.
        Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model.
        J Vasc Surg. 2011; 54: 644-653
        • Troutman D.A.
        • Chaudry M.
        • Dougherty M.J.
        • Calligaro K.D.
        Endovascular aortic aneurysm repair surveillance may not be necessary for the first 3 years after an initially normal duplex postoperative study.
        J Vasc Surg. 2014; 60: 558-562
        • Go M.R.
        • Barbato J.E.
        • Rhee R.Y.
        • Makaroun M.S.
        What is the clinical utility of a 6-month computed tomography in the follow-up of endovascular aneurysm repair patients?.
        J Vasc Surg. 2008; 47: 1181-1187
        • Karanikola E.
        • Dalainas I.
        • Karaolanis G.
        • Zografos G.
        • Filis K.
        Duplex ultrasound versus computed tomography for the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Where do we stand now?.
        Int J Angiol. 2014; 23: 155-164
        • White S.B.
        • Stavropoulos S.W.
        Management of endoleaks following endovascular aneurysm repair.
        Semin Interv Radiol. 2009; 26: 33-38
        • Schanzer A.
        • Messina L.M.
        • Ghosh K.
        • et al.
        Follow-up compliance after endovascular abdominal aortic aneurysm repair in Medicare beneficiaries.
        J Vasc Surg. 2015; 61: 16-22.e1
        • Png C.Y.
        • Tadros R.O.
        • Faries P.L.
        • et al.
        The effect of age on post-EVAR outcomes.
        Ann Vasc Surg. 2016; 35: 156-162
        • Xiong J.
        • Wu Z.
        • Chen C.
        • Guo W.
        Chronic obstructive pulmonary disease effect on the prevalence and postoperative outcome of abdominal aortic aneurysms: a meta-analysis.
        Sci Rep. 2016; 6: 25003
        • Yun W.S.
        • Park K.
        Iliac anatomy and the incidence of adjunctive maneuvers during endovascular abdominal aortic aneurysm repair.
        Ann Surg Treat Res. 2015; 88: 334-340
        • Wyss T.R.
        • Dick F.
        • Brown L.C.
        • Greenhalgh R.M.
        The influence of thrombus, calcification, angulation, and tortuosity of attachment sites on the time to the first graft-related complication after endovascular aneurysm repair.
        J Vasc Surg. 2011; 54: 965-971
        • Fairman R.M.
        • Nolte L.
        • Snyder S.A.
        • Chuter T.A.
        • Greenberg R.K.
        • Zenith Investigators
        Factors predictive of early or late aneurysm sac size change following endovascular repair.
        J Vasc Surg. 2006; 43: 649-656
        • Vorp D.A.
        • Vande Geest J.P.
        Biomechanical determinants of abdominal aortic aneurysm rupture.
        Arterioscler Thromb Vasc Biol. 2005; 25: 1558-1566
        • Veith F.J.
        • Baum R.A.
        • Ohki T.
        • et al.
        Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference.
        J Vasc Surg. 2002; 35: 1029-1035
        • Jones W.B.
        • Taylor S.M.
        • Kalbaugh C.A.
        • et al.
        Lost to follow-up: a potential under-appreciated limitation of endovascular aneurysm repair.
        J Vasc Surg. 2007; 46 (discussion 440-1): 434-440
        • Kret M.R.
        • Azarbal A.F.
        • Mitchell E.L.
        • Liem T.K.
        • Landry G.J.
        • Moneta G.L.
        Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection.
        J Vasc Surg. 2013; 58: 25-31
        • van Keulen J.W.
        • van Prehn J.
        • Prokop M.
        • Moll F.L.
        • van Herwaarden J.A.
        Potential value of aneurysm sac volume measurements in addition to diameter measurements after endovascular aneurysm repair.
        J Endovasc Ther. 2009; 16: 506-513
        • Koole D.
        • Moll F.L.
        • Buth J.
        • et al.
        Annual rupture risk of abdominal aortic aneurysm enlargement without detectable endoleak after endovascular abdominal aortic repair.
        J Vasc Surg. 2011; 54: 1614-1622